HomeMy WebLinkAboutX2021-3390 - Permit ApplicationF rent Form _ Wo et for Combo Building & Solar Permit
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F- Comm I s I City of Newport Beach -Building Division
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F -Building [ Grading rainage [;Elec j -'Meth Plum Cu yd Cut Cu Yd Fill
Project Address (Not mailing address) [ Flood F_,F,ire F_,' Ligq F_ LLandslide /A Floor Suite No
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Description of Work AS
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New/Add SFF7777 Remodel SF I Garage/New/Add
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OWNER'S NAME Last - Eg First -JQ S ('
Owner's Address Owner's E-mail Address
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City eLw 924 State Zip �- Telephone �( G� 1 Z YS 7 �L--
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APPLICANT'S NAME LastFirst
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Applicant's Address Applicant's E-mail Address
1100 02ANG6-T-H?_oAe STC-
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City
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ARCHITECT/DESIGNER'S NAME Last e1Jf�0 R!!1 'First 13C tv r -(--d_ _ Lic. No.�—
Architect/Designer's Address Architect/Designer's E-mail Address
City State I Zip — Telephone
ENGINEER'S NAME Last First Lic. No 1_
Engineer's Address Engineer's E-mail Address
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City State Zip TelephoneF—
CONTRACTOR'S NAME/COMPANY Lic. No. �, ClassF
Contractor's Address Contractor's E-mail Address
City State �— Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. V - t,